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44 year old male patient, 10 days with high fever, pain in right hypochondrium, night sweats and loss of appetite. The patient lives in a tropical country.

Caption:Fig 1. Oblique view, right hypochondrium.

Description:The sonogram shows the right hepatic lobe, junction of the hepatic veins with the inferior vena cava and a partial view of the left lobe which exhibits a large rounded hypoechoic mass.

Caption: Fig 2 Oblique view, right hypochondrium.

Description:Color Doppler demonstrates flow in the hepatic veins but no flow within the lesion.

Caption:Fig 3 Transverse view right hypochondrium/epigastrium

Description:A large rounded mass with an irregular peripheral hypoechoic rim and a predominant anechoic center occupies much of the left lobe of the liver. There is enhanced sound transmission deep to the lesion, indicating fluid content. Note the mass effect on the anterior border of the left lobe of the liver.

Caption:Fig 4 Sagittal left lobe of the liver

Description:In this plane near the margin of the lesion, the lesion occupies segments II and III and causes distortion of the liver shape. The irregular, poorly defined walls of the lesion and acoustic enhancement are both well demonstrated in this image.

Differential Diagnosis

Hepatic Abscess

Intra-hepatic hematoma

Hepatic Tumor

Final Diagnosis

Hepatic Amebic Abscess

Discussion

Amebiasis is an infectious disease caused by the protozoan Entamoeba histolytica. Worldwide in distribution, it affects 20% of the world population. However, it is most widespread in the tropical countries. The distribution is 0-10% in the northern countries and 5-60% in the tropics. Many of the reported cases in non-tropical countries usually are cases of patients who have visited those areas. Hepatic abscess is the most frequent manifestation of extra-intestinal disease.

Ultrasound has proven to be an excellent method for the diagnosis of hepatic abscess. Amebic hepatic abscesses generally present as a solitary lesion, but they can also be multifocal, usually with poorly defined or shaggy walls. When lesions become visible to ultrasound, they generally have a round or oval shape, and are mostly localized in the periphery of the right lobe. They are typically hypoechoic with fluid content or may present with a complex internal echo pattern (depending on the degree of liquefaction). These lesions exhibit some degree of posterior acoustic enhancement in 70–80% of cases.

The abscess cavity may last for weeks or months after medical treatment has been completed, with an average of seven months. In some cases ultrasonographic changes can persist for 12 months and more, without clinical significance.

Case References

Fernandez L. “Amebiasis” in Manual of Diagnostic US in Infectious Tropical Diseases

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